Cervical spondylosis, also known as spondylosis, occurs due to changes in the shape and structure of the vertebrae.Despite the fact that the cervical region is quite short compared to the total length of the spine, it is perhaps the most important part of the spine.Each pair of adjacent vertebrae forms the intervertebral foramen, through which nerve roots emerge and are directed to each muscle and organ of the upper half of the body.Important vessels supplying blood to the brain pass through other openings - in the lateral vertebrae of these vertebrae.
Causes of cervical spondylosis
Causes of osteoarthritis are:
- injury,
- “sedentary” works at a screen placed below eye level,
- manual labor that involves carrying heavy loads,
- driving for long periods of time,
- work “on the phone” without using the remote device (in this case, the operator presses the receiver to the ear with his shoulder)
- Structural features (torticollis, congenital changes in cervical vertebrae, short neck)
Formation of pathological changes in the vertebrae
With osteonecrosis, small sharp points begin to form at the edges of the vertebral body, which can damage nearby structures.Most often, this occurs in response to excessive loads on the cervical spine and not just as a result of “aging” of the joints between the vertebrae (remember that osteoarthritis was previously considered a natural, “age-related” degenerative disease, like osteoarthritis).As the disease progresses, the vertebral cushions become denser and the height of the discs gradually decreases.These discs often act as shock absorbers between vertebrae and prevent damage to spinal roots.With progressive osteonecrosis, protrusion (herniation) of the nucleus pulposus of the intervertebral disc occurs, on which, during the course of the disease, pressure increasingly increases while the "holding" ligaments on all sides weaken.This herniation can also compress spinal structures and cause neurological manifestations of the disease.
What are the symptoms of cervical spondylosis?
Cervical spondylosis with pain syndrome
Any pain in the neck area makes one suspect cervical spine disease.According to the increasing intensity of the pain syndrome, they are divided into 4 stages. At first the patient feels numbness, tingling, a feeling of "tightness" in the area of a certain muscle group, in the fourth stage - the most severe - the pain is so intense that it leads to immobility and loss of performance of the patient.
In addition to pain in the neck and occipital region, the patient also noted “referred” (diffuse) pain in the upper extremities and the area below the scapula of the chest.
Cervical spondylosis with radicular syndrome
The involvement of nerve roots in this process is manifested when pain, numbness and tingling sensations spread to the lower jaw, upper back, forearms and fingers.At the same time, the patient notices that he “seems to be resting” and sleeps uncomfortably.There is morning stiffness in the finger joints, lasting no more than 10-15 minutes.With the development of radicular syndrome, on examination, a decrease in muscle strength of the upper limbs can be noticed.
Cervical spondylosis with “vertebral artery syndrome”
Involvement of blood vessels in this process (compression due to protruding hernia or bone spur) is indicated when the patient complains of frequent headaches, especially after being in a certain position for a long time, when tilting the head back (for example, when swimming breaststroke), if there is tinnitus and dizziness.This clinical condition is clearly identified by ultrasound (with “Doppler mapping mode”).Ultrasound shows tortuosity of the vertebral arteries and narrowing of their lumens.In this case, we may be talking about surgery, since a pronounced change in blood flow in the vertebral artery is a risk factor for stroke.
Osteonecrosis of the cervical spine with “heart syndrome”
This syndrome forces the patient to first see a cardiologist, since the main complaint concerns pain in the left half of the chest, in the area under the shoulder blade, that weakens or becomes more intense when performing physical activity or changing body position.After excluding myocardial infarction and other heart diseases, the patient was hospitalized under the supervision and treatment of a neurologist and orthopedist.
Diagnose
To clarify the diagnosis, four methods are used: X-ray, ultrasound, computed tomography and magnetic resonance imaging.
The most accessible method is still X-ray of the cervical spine;the most useful information is radiographs in lateral projection (“side view”).This method allows, at a first approximation, to determine the presence of injuries and overall structural changes in the vertebrae.
Ultrasound examination (ultrasound) is performed to clarify the condition of the vertebral artery.Using this method, it will be determined whether blood flow is impaired and, if so, what obstacles have arisen and where they are located.
Computed tomography (CT).Allows you to more accurately assess the condition of bone structure, the level of bone tissue density, and allows you to see smaller bone spurs (bone growths) than is possible with x-rays.
Magnetic resonance imaging (MRI).This type of examination is indispensable if there is a doubt about the presence of a hernia, the exact location of spinal cord damage and the extent of this damage.This study is necessary if the question of surgical (operative) treatment of diseases of the cervical spine arises.
Treatment of cervical spondylosis
Drug treatment
The standard set of measures for the treatment of cervical spondylosis reflects the goals of treatment: pain relief by eliminating painful muscle spasms and nerve root inflammation, and increasing spinal mobility.To achieve these goals, they are used mainly using pain relievers, NSAIDs - non-steroidal anti-inflammatory drugs, muscle relaxants.It is important to remember that self-medication with drugs from these groups can be dangerous because of the possibility of misinterpreting symptoms as well as underestimating the side effects of these drugs.Topical (skin) NSAIDs in gel form are widely used, and once the pain stops, these same medications can be used as ointments.
To treat osteoarthritis at a deeper “basic” level, slow-acting systemic drugs are used.These substances restore the cartilage structure of the vertebrae and prevent further damage.The treatment process is long, the effect lasts for many months.
Cervical spondylosis is significantly different from the pathology of other parts of the spine.Pain in the neck area in this case can be provoked not by signals from sore spinal nerves, but by chronic painful muscle tension - all this is called myotonia syndrome.This is a completely "benign" condition, responding well to treatment with the same set of drugs: non-steroidal anti-inflammatory drugs, muscle relaxants, and intramuscular "blocking" drugs with steroids.Typically, doctors detect sharp pain when palpating so-called “trigger” points along the entire cervical spine, as well as in the muscle area of the upper shoulder girdle.More often, this pathology occurs in women, most of whom are under 40 years old.Despite the severe pain syndrome, the neurovascular structures remain intact and blood flow to the head is not affected.
Manual therapy
This treatment may be effective for recent pain (usually due to minor trauma, subluxation) in the neck that is not accompanied by dizziness or other changes in the nervous and circulatory systems.Manual therapy is allowed only after a thorough examination;In addition, the doctor performing this procedure must have enough experience in the field of trauma and orthopedics.For “old” forms of the disease, using manual therapy is very dangerous!
There are two known methods of this type of intervention:
- manipulation (short-term sharp impact of a significant force aimed at eliminating subluxation, the famous “bone-clicking” sound);
- mobilization (this method is based on gentle stretching of the neck after warming up and relaxing the neck muscles).
A combined method is also used, based on the combination of two main methods.It is important to remember that in addition to these contraindications, manual treatment is prohibited for any diseases accompanied by hypertension, for any pathologies of the thyroid gland and ENT organs.
Treatment of cervical spondylosis at home
Exercises to treat cervical spondylosis
The first and main rule for beginners in physical therapy is not to perform exercises while overcoming painful sensations.Of course, you should not start in the "acute" phase, when the pain has just appeared.Another important recommendation is to avoid sudden movements and circular movements in the cervical spine.
Each workout session should begin with a brief and gentle self-massage of the neck muscles.
Next is the “warm up” part:
- Arms lowered along the body, shoulders level, back straight (you can check posture by gently pressing your heels, shoulder blades and buttocks against the wall).We walk in place for 1 minute with our whole feet, 1 minute with our toes, 1 minute with our heels.
- The starting position is the same.We clench our hands into fists, raise and lower our shoulders, and straighten our arms.The movement is slow, we do 20 repetitions, the last increase is longer than 5 seconds.We make sure that the neck muscles are not strained.
- The starting position is the same.We alternately tilt our head to the right, then to the left.Smooth movements, one tilt for 8 counts, at the highest tilt point - hold for 8 seconds.
- The starting position is the same or sitting on a hard chair.Tilt your head gently forward, at the extremity - hold for 8 seconds
- The starting position is the same or sitting on a hard chair.Slowly tilt your head forward until your chin touches your chest, then slowly turn your head to the right (4 counts) and left (4 counts).Avoid excessive muscle tension.
- The starting position is the same or sitting on a hard chair.We raise our shoulders for 4 counts, then gently lower them for 4 counts.10 repetitions.
- The starting position is the same or sitting on a hard chair.We raise our shoulders, but now we make circular movements from front to back, for 8 counts.10 repetitions.
- We straighten our back and check our posture.For 4 counts, we bring our shoulder blades together behind our back, trying to connect them, at the end we linger for 8 seconds, then return to the starting position.
Pillow
As already mentioned, increased tone of the neck muscles is the first and often the main cause of the development of cervical spondylosis.Choosing the right pillow and mattress to ensure a relaxing and comfortable sleeping position is no less important than exercise, physical therapy and medication.
When choosing a mattress, pay attention to the composition of the filler (products that are at least half made from shredded coconut, that is, have sufficient hardness, are suitable).Soft spring mattresses do not provide enough spinal alignment.The most optimal sleeping position is lying on your side, with one or both knees pulled up toward your stomach.The pillow should be placed so that it fills the entire space between the shoulders, ears and mattress, and the top (crown) of the head is on the same horizontal line as the spine.Too high and too low should be avoided as well as soft pillows.The ideal option is a product with an ergonomic shape, that is, in this case there is a small pressing roller on one side.
General recommendations
Pay attention to your posture.When walking or standing, the correct posture is with the chest pushed forward and the abdomen pulled in.
Avoid sitting for long periods of time.A simple rule to prevent cervical spondylosis is known: after every 60 minutes of work, it is necessary to walk or warm up for 10-15 minutes.
Work chairs must have a headrest or high backrest.
When sitting, your feet should be on the floor and your neck should not be tense.To do this, use special orthopedic devices: cushions under the neck when driving a car, pillows under the back.
Avoid lifting heavy objects.If necessary, kneel down, support a heavy object against your torso, then stand up gently, using the strength of your leg muscles, not the "pull" of your back.
Don't bend over with straight legs.Use a stand or work surface to bring the subject closer to you instead of tilting your face toward the subject.Try doing homework while sitting in a chair or on an exercise ball.
If you must use a mop, broom or rake, do not strain your arms, back, neck or lean to one side.
Avoid swimming breaststroke.